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All so new and overwhelming . . .

Hi - I'm in tears. I'm not sure what to do, think, feel or anything... I apologize if this note is very lengthy... I need to vent out...

I have given natural birth to two beautiful kids - 1 girl, 1 boy. Until my third, a son, came along, the whole journey has been different, overwhelming and new - emotionally, physically and mentally.

I gave birth to my son on April 18th, 2009 - he was 34 weeks (6 weeks early) and stayed at NICU for 16 days before coming home on May 4th. Water broke - went to the ER - his heartbeats were dipping so had an emergency c-section. Found out later his umibicial cord was in a TIGHT KNOT *and* the cord was wrapped around his neck once. I can't imagine what will happen to my son if the water never broke! We were blessed to have him alive today. He will be 8 weeks this Saturday. His due date was supposed to be May 28. So, if he was born full term, he'd be 2 weeks this Thursday. This is my first premature baby experience.

Also, it was my first c-section experience (I hate it) after giving natural birth to my first two babies. I didn't have the baby with me in the room - he was taken and stayed in NICU. I cried so hard - hit me so hard - that I couldn't bring my boy home when I was discharged. I didn't want to go home. It wasn't "home" until my son was home.

I stayed with him in NICU the whole time until he was discharged. I was fortunate that I was able to stay in my own room on the same NICU floor where my son was at - in his own room. The NICU had private rooms for all premie babies. While I stayed there - I focused on pumping breastmilk. It wasn't coming out at all until like a week after I gave birth. Also, seeing my son as often as I can - be there when to nurse/bottle him. At the same time, resting and recovering from c-section.

My son was born 4lb 15oz. He was healthy except was on feeding tube. At 34 weeks, it was when babies learn how to suck. I come in and try to nurse him before they feed him with formula until my breastmilk came in. He'd suck few times and go to sleep, exhausted. Over time, he'd nibble - rarely suck and swallow. Very few times - he made it. But, most part, nursing wasn't as successful. My expectation with nursing was high and different because of my experience with my first two. It took me a while to change my thinking and increase more patience. It was hard but I adjusted. Later on, I was told that if I want to bring the baby home sooner, do bottle. I went along with their suggestions. I'd nurse first for few minutes or longer if I can, then bottle-feed my breastmilk. After few days of success in bottle feeding, they took out the feeding tube. He gained weight. Added ensure powder to my breastmilk to keep gaining his weight. He went home weighing 5lb 4oz on May 4th. One week later at the doctor's check up, he gained 5 oz. Two weeks later, he gained 6lb 11.5oz. He's doing great with breastmilk (plus ensure powder) through bottle. I kept up with pumping. I try to do it every 4-6 hours. Sometimes go longer to 8-10 hours. Few days after the 2nd doctor check up, Ensure powder ran out and we decided to go with pure breastmilk and hope he is gaining weight. We don't have a weight scale - we plan to buy one tomorrow and hopefully he is gaining weight.

Lately, I've not been consistent with nursing and pumping. Kind of hard with my youngsters around and all things that are happening around at home. Big adjustments for us. My 2nd child age 2 1/2 is a mommy boy - he has hard time adjusting with baby around. It was easier to pump and bottle feed him. I'd try to nurse when I can. Right now, I'm trying to nurse him more but it's so hard. Sometimes I feel like he prefers bottle over my nipples. He seems to suck my nipples like bottle and it hurts like hell. Sometimes he'd suck and swallow for few minutes, then falls asleep tired still. Sometimes he'd just nibble, not sucking/swallowing milk at all. I'm not sure if he can accept/like drinking from my breasts/nipples over bottles? I'm not sure how to have him transfer from bottle to my nipples. I worry if he will suck enough milk from my breasts. He'd suck for like 5 minutes then falls asleep. Sometimes he'd suck/swallow good for 10 minute from ONE breast then falls asleep and doesn't wake up until next feeding in 3-4 hour later. Is it ok to just feed him from one breast for 10 minute? Will that be enough for him? Or must switch breasts - each breasts 10 min feeding?

My breasts feels unhealthy and in pain. I feel constant burning near my nipples and I do feel pins and needles, painful let-downs. I don't remember feeling painful let downs with my first two babies. I breast fed my first two babies for one year. I'm not pumping as much and on regular schedule - it gets tiring for me. I don't feel as full as before... I'm afraid my breastmilk supply will go down? How do I keep up with breastmilk supply? How do I know if I am making enough? What do I do when he goes through growth spurts? This is if he's not nursing on my breasts full time yet... and still bottle-fed?

I'm not sure what I want to do or what I should do. I'd like to nurse him full time like I did with my first two babies. Bottle-feed him when needed. I'm tired of pumping too but I am willing to keep up with it if needed. I feel I do not know enough, what to think, expect, etc with a premature baby that my son is.

Again, I'm sorry this is so long. Thanks for hearing me out. Any of your inputs will be greatly appreciated. I plan to contact one of the consultant nearby maybe tomorrow and take it from there.

Re: All so new and overwhelming . . .

Hi Mama! Congratulations on the new baby. I'm sorry his arrival has been such a rocky time for you and your family. But it sounds like you are really giving this your all and you deserve a big pat on the back for that!

Have you contacted a lactation consultant? Hands-on help is really the best thing you can have when you are struggling. Look for a LC who is also an IBCLC- they tend to have the most knowledge. If you can't find a LC, contact your local LLL leader.

It sounds like one of the things you are worried about is how much your baby is getting at the breast. Counting diapers should help- if your baby is having the right number of wets and poops then all is well, since good output = good input. You could also rent a professional grade baby scale- your LC will have one or will know where to get one. By weighing your baby before and after feedings, you will be able to measure exactly how much milk he transferred during the nursing session.

Bottlefed babies often are reluctant to accept nursing at the breast. It's so much more work than a bottle! (Lazy little things, aren't they! ) But there are some things you can do to help a bottlefed baby accept the breast, including:
- Express a few drops of milk before latching on- the taste may get your baby to suck longer.
- Co-sleep with your baby if you aren't already. Many babies who fight the breast during the day will accept it at night when they are too relaxed to fight.
- Make bottle-feeding as much like breastfeeding as possible- when it is time to bottlefeed, open your blouse, cuddle baby close to your bare chest, and tickle his lips with the bottle nipple until he opens wide. Don't let him learn sloppy latching habits by slipping a bottle into a half-open mouth.
- Try giving supplements by supplemental nursing system instead of by bottle- that way baby learns that all meals come from the breast.

My breasts feels unhealthy and in pain. I feel constant burning near my nipples and I do feel pins and needles, painful let-downs.

See your LC and or your doctor/midwife about this: burning is a symptom of thrush and thrush is more common in moms who have had antibiotics during/after birth, as is common with c-section moms.

Regarding your older kids, sometimes it helps to have a special basket of toys and games that comes out only when the newborn is being nursed. That way nursing time is special for everyone.

Hang in there!!! You are doing a terrific job in difficult circumstances!

Re: All so new and overwhelming . . .

I am curious how SNS works?? I have never seen that before.

The SNS is a bag of milk or formula that hangs around your neck. A tube comes out of it, and you position the tube along-side your nipple when you latch your baby on. (This is tricky and can take a bunch of practice to get right.) The baby feeds simultaneously from breast and SNS tube. Since the baby is not feeding exclusively from the breast, it is generally very important to continue to pump.

I'll start trying to do co-sleep. Orrin (my son) does seem to fight more during the day.

Great! Check out the tips on safe co-sleeping on the 2nd page of this article.

How do you help your breast let down milk before nursing? Sometimes it takes a bit longer for my breasts to let down. Orrin gets frustrated when he's not getting any milk right away like the bottle.

Some moms pump a little bit before latching the baby on, just to get the milk flowing. Others hand-express. Some moms just drip a little bit of milk onto the nipple before latching the baby on.

But what does IBCLC stand for?

International Board-Certified Lactation Consultant. Some LCs are just nurses who took a short course so they can help new moms in maternity wards. IBCLCs have a long course of study- I think it takes a year or so to complete?- and are usually a lot more helpful to a mom with serious issues.

Re: All so new and overwhelming . . .

Congrats on the birth of your son and for continuing to pump! It is hard! My son was born on January 17th - he was 10 weeks early. He was in the NICU for 7 1/2 weeks and I was barely able to nurse him while he was there (I tried, but like you was told give bottles to get him out sooner, and got resistance to nursing him from most people there. He was on the feeding tube until just a few days before he was discharged, with parts of feedings/some feedings done with a bottle during his last week or two there). Once he was home and continuing to gain weight well, I decreased the bottles and would nurse him - I got help from IBLC lactation consultants and rented a baby scale to weigh him before and after feedings. I kept track of everything on paper to show his Dr's when he had an appointment. We used a nipple shield for a while too.

Basically how I transitioned from bottle to breast is I offered him the breast first, but before he was really hungry (he was too impatient to try to latch if he was really hungry). I would hand express a little milk onto my nipple and then rub my nipple across his lips until he opened his mouth and then I'd shove my nipple in! I had to hold his head (at the base of his head, where it meets his neck) with one hand and then I would use my other hand to squeeze my breast (I'd hold on either side of my aereola and compress it to make it thinner for him to be able to latch). If that doesn't make sense, let me know and I'll try and clarify. I had to do this the whole time he nursed for weeks to keep him latched on. Once I knew he "could" nurse, meaning he had done it a few times and was satisfied after and the scale showed he was taking in milk, I stopped offering him a bottle afterwards. After a while of doing this combination breast/bottle I decided to forgo the bottles completely.

I offered to nurse him often and if he didn't, I just tried again after I changed his diaper and he was a little more awake. I kept telling myself that he CAN nurse and WILL if he's hungry. I was patient, had my sister look after my 2yr old while I tried, and if he wouldn't, then I'd take a break and try again in a bit. This was the point where nursing really picked up for us. He would get a bottle 2 times a day (due to needing to put medicine in the milk to give to him) but I slowly decreased the amount of milk and would nurse him after.

I also wore him a lot in a Moby Wrap so he was close to my breasts and I could learn his cues better, while still being able to take care of my toddler. I highly recommend this wrap to you! You can also hold him skin-to-skin in this wrap and you would be covered enough around your own house. Wearing him in the wrap, even now (he's 5mo, 2 1/2mo adjusted) seems to increase my milk too - I feel much fuller after wearing him for a while than if he's sleeping on his own.

I also became inconsistent with pumping as time went on, it got old really fast. I pumped every 3 hours during the daytime, but I quit pumping during the night before he came home from the hospital. However, it is really important to make sure you're pumping enough to keep your milk supply up so as he transitions to more nursing, the milk is there for him. (My toddler still nurses, so she helped keep my supply up along with the pumping.) You want to make sure that your breasts are getting drained - if he's not taking enough from you, pump a little after so they do. I know it's hard and time consuming, but it's worth it. I'm so glad I did all the pumping I did, even when I REALLY wanted to quit, because now we're nursing on demand and I'm not pumping anymore, it's great. Wouldn't have been possible without the pumping though!

So, all this to say: definitely get help from an IBLC Lactation Consultant, renting a scale is a great idea - but rely on your gut too, try doing skin-to-skin as much as you can, offer baby the breast often - before really hungry, and remember that you absolutely can make this switch - it will take patience, time, and energy, but it's so worth it! And - putting the effort into switching now means less time spent pumping later, when you can nurse exclusively!

Feel free to ask more questions, we're here for you mama!

Mommy to:

Emmalynn Marie
Born at 37 weeks on 12/22/06
5lbs 1oz 19 1/2in

Owen Charles
Born at 29 wks 6 days on 01/17/09
2lbs 14oz 15in
In NICU for 2 months

Re: All so new and overwhelming . . .

Oh, and for what it's worth, my first baby was a natural birth that went extremely well. My son, however, was a different story - I had problems throughout the pregnancy, bleeding, feeling something wasn't right, etc. and went to the OB's office and the hospital to be checked out several times but no one found anything. Looking back I realize my water broke - sometimes leaked fast, sometimes leaked slowly, at 25weeks. This wasn't realized until I was 28 1/2 weeks along, via an ultrasound because I complained again that something wasn't right. The ultrasound showed I had only 1 small pocket of amniotic fluid and so I was put in the hospital on bedrest. I had him at 29weeks 6days and he weighed 2lbs 14oz. He was c-section, because he was breech. This whole experience with my son's birth and NICU stay was so the OPPOSITE of what I wanted with this birth. I never wanted a c-section, couldn't bond with my baby for so long, etc - it has been the most difficult experience of my life. I still struggle, although less often, with how disappointed/sad/frustrated with how everything has been and often people who haven't experienced a premature delivery and NICU stay don't understand - they see a "normal" looking baby and say "but it all turned out o.k." But there's so much more to it than that. If you need to vent or anything, I'm here - you can email me too. There's preemie-l boards too (plug that into google) if you want to join those and have support from a lot of mothers of premature babies.

Mommy to:

Emmalynn Marie
Born at 37 weeks on 12/22/06
5lbs 1oz 19 1/2in

Owen Charles
Born at 29 wks 6 days on 01/17/09
2lbs 14oz 15in
In NICU for 2 months

Remember, you are not managing an inconvenience; You are raising a human being ~ Kittie Frantz
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Re: All so new and overwhelming . . .

Hi, I just wanted to let you know you're not alone. I had my daughter 10 weeks early by emergency c-sect, and she spent 7 weeks in NICU, during which I was expressing up to 8 times a day to produce milk to tube feed her. She began to attempt breastfeeding at about 35 weeks gestation, but would tire very easily, so would get top ups by tube. We eventually brought her home once we'd switched to top ups by bottle. Some hospitals send the prems home still on tube top ups, but not the one I went to. As I didn't live near the hospital, and couldn't be there for every feed, we went the bottle top up route, so she could come home fully suckle feeding. We didn't suffer with nipple confusion which was a relief, as it is something I was worried about.

The thing I did to help when expressing was to spend skin on skin time with my baby, even if she wasn't feeding. This was mostly in the hospital.

Once we got home, I dropped the top ups after about 2 weeks and went to demand feeding during the day, with bottle EBM at night, and then went to exclusively breast fed by about 2 months after we brought her home. I did pretty much end up wearing my baby a lot of the time, which in your situation will be a lot harder with other children. Front packs or wraps are good for this.